Factors Shaping MSM-Focused HIV Prevention Policies and Activities in Ghana

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DESCRIPTION (provided by applicant): This proposal aims to acquire the qualitative research methods training necessary to develop as an independent academic researcher in the field of HIV/AIDS by preparing and conducting a qualitative research study on HIV prevention policies in Ghana targeting men who have sex with men (MSM). Background: men who have sex with men (MSM) have been overlooked in African government's AIDS National Strategic Plans despite evidence that same-sex sexual activities and MSM HIV transmission do occur throughout the continent. Over the past five years however, HIV prevention efforts addressing MSM have increased and millions of dollars of funding have flowed from international funding source for these efforts. Particularly in Ghana, where the MSM HIV prevalence rate is over ten times the national average, the government AIDS agency is taking steps to address the epidemic among this key population. Given that anal sex between men in Ghana is illegal and culturally unaccepted, the purpose of the proposed study is to understand how the Ghanaian government came to prioritizing MSM in HIV prevention policies and what cultural, social, and political factors affect the development, implementation, and reception of these policies. Aims: The specific aims are 1) to explore why and how HIV/AIDS prevention policies focusing on MSM in Ghana are developed and how social, cultural and political factors, including the legal context, which criminalizes same-sex sexuality, and international AIDS prevention guidelines for MSM, affect these policies; 2) To explore how MSM HIV prevention policies are being implemented, what discrepancies might exist between the policies and their implementation, and what factors can account for the gap; and 3) To examine how MSM in Ghana perceive and experience these HIV prevention policies and programs and their effects. Methods: Consistent with my training objectives, the study will apply an ethnographic and sociological approach to understanding the cultural, political, and social contexts and implications of these policies. Specifically, I will conduct 35 in-depth, semi-structured interviews with policymakers, HIV prevention service providers, and MSM who use these services; participant observations of policymakers' work group meetings and functions, HIV prevention fieldwork, and social settings; and 2 focus group interviews with 20 peer educators. While it is critical that many African nations are taking steps to address the epidemic within the MSM population, it is also vital to understand how this process is occurring and the attitudes, perceptions, and structural factors informing it given the complex and contradictory legal and cultural contexts that criminalize and stigmatize anal sex between men. No known study of this nature has been conducted in Ghana or the region.